[New combined endoscopic method of Zenker's diverticulum treatment].

Endoscopic treatment methods are currently a priority in the treatment of patients with Zenker's diverticulum. The optimal endoscopy should combine the positive aspects of traditional and tunnel technologies and be fairly simple from technical standpoint, the most radical and safe for the patient. This work evaluates the effectiveness of endoscopic cricopharyngeal esophagomyotomy using combined methods of treating patients with Zenker's diverticulum. From June, 2014 to December, 2018 A. S. Loginov City Clinical Scientific Centre performed 30 surgeries using a new combined technique. The average surgery time is 37.5 minutes. No postoperative complications. Control X-ray examination has shown almost complete absence of the residual cavity of the diverticulum. The combined endoscopic method of treating patients with Zenker's diverticulum allows to create conditions for preventing the recurrence of the disease, thereby ensuring the best result of treatment.

[Endosonography in the T-staging of pancreatic cancer].

Pancreatic cancer is the sixth among all oncologic diseases and takes the 4th place on cancer mortality in the world. Pancreatic cancer has poor prognosis. Survival for the 5 years after diagnosis is less than 5%. The objective was the evaluation of endosonography diagnostic significance in identification of tumor vascular invasion and tumor resectability. The treatment results of 82 patients with pancreas adenocarcinoma, technique of endosonography, the types of echo-endoscopes and ultrasonic criteria of vascular invasion are presented in the article. Tumor invasion was suspected in 48 patients (58.5%) during endosonography. Tumor invasion into the blood vessels of the upper abdomen was observed in 51 patients (62.2%). Endosonography sensitivity for detection of tumor invasion was 90.2%, specificity - 93.5%, accuracy - 91.5%. In view of modern criteria of pancreatic cancer resectability endosonography is leading method for selection of patients for surgical treatment.

[Diagnostics and tactics of gastrointestinal stromal tumor surgical treatment].

45 patients with gastrointestinal stromal tumors (GIST) were under observation. In 30 cases the GIST came from the stomach, in 8 cases - from the duodenum, and in 7 cases - from the small intestine. In all cases the diagnosis was confirmed by immunohistochemical study. Specific clinical manifestations of GIST were absent. Ultrasound detected the tumors that were more than 30 mm in diameter. The most informative diagnostic technique was computerized tomography with a contrast. All patients were operated. 29 patients with a diameter of tumor more than 50 mm had traditional open operation. In case the tumor oversteped the limits of the capsule or capsule's damage during the operation, the extirpation of the gastrocolic omentum was done. If the GIST were less than 50 mm they were extracted with the robot-assisted or laparoscopic methods. The long-term results of the treatment (from 3 to 60 months) of 28 patients were analyzed. 3 patients died of disease progression, 1 patient had metastasis in liver and 24 patients hadn't the signs of relapse.

[Endoscopic ultrasonography in determining resectability of the pancreatic adenocarcinoma].

The publication presents the results of the examination and treatment of 82 patients with pancreatic adenocarcinoma. The main objective of the work is the evaluation of endosonography diagnostic significance in identifying tumor vascular invasion and determining resectability of the tumor. The paper describes an EUS methodology, type of echoendoscopes and ultrasound criteria for tumor invasion to the blood vessels. Vessel invasion during endosonography was suspected in 48 (58.5%) cases, according to surgery data, tumor invasion into upper abdomen vessels was detected in 51 patients (62.2%). Sensitivity of endosonography in detecting vessel invasion was 90.2%, specificity--93.5%, accuracy--91.5%. Endosonography being in trend of present day ideas about the criteria of pancreatic cancer resectability is the leading method in the selection of patients to surgery.

[Endoscopic diagnostics and treatment of submucous tumors of the upper gastrointestinal tract].

The endoscopic ultrasonography (EUS) is considered to be the leading method of diagnostic of the submucous gastrointestinal tumors. Results of diagnostics and treatment of submucous tumors of the upper gastrointestinal tract in 38 patients were analyzed. EUS was performed in 37 (97,4%) of patients, which allowed to detect the origin, size and localization of the tumor. The differential diagnostic algorithm was suggested together with certain indications for various surgical treatment modalities. Thereby, endoscopic ablation is reasonable when the tumor invades not deeper than muscle plate of mucosa or the submucose layer. Laparoscopic full-layer resection of the organ wall is necessary when the tumor invades the muscle layer. Larger tumors or those of any size, but with preoperative signs of high malignancy must be eradicated through laparotomy, meeting all principles of oncology.

[Complications after radio-frequency thermoablation of liver tumors].

Results of treatment of 124 patients (228 operations) were analyzed. Complication rate was 19.2%, whereas severe complications were observed in 4.3%. Complications, requiring minimally invasive surgery, on the contrary, conservative treatment , as well as risk actors were defined. Possibilities of radio-frequency thermoablation complications prophylaxis were suggested.

[Endoscopic ultrasonography in the diagnosis of neuroendocrine tumors of the pancreas].

In this article presented results of examination and treatment of 30 patients with suspected neuroendocrine tumors (NEO) of the pancreas during the period from 2007 to 2010. In the 22 cases were identified solitary pancreatic tumor, and 4 observations--multiple. Functioning NEO were detected in 19 observations, dysfunctional--7. The main objective of endosonography was a differential diagnosis of NEO with adenocarcinoma and chronic pancreatitis, as well as the topical diagnosis of small tumors that are inaccessible by other imaging beam method. Among the 27 patients operated on NEO confirmed in 26. In 1 case was revealed adenocarcinoma. Endosonography in NEO-functioning method of diagnosis is a priority, having the highest sensitivity, specificity and accuracy among all modern radiological methods of diagnosis.